tbuckley/cabot-search huggingface dataset:
Abstract 11879: Von Willebrand Factor Activity and Closure Time With Adenosine Diphosphate During Transcatheter Mitral Valve Repair
Authors: Sandra Hadjadj, Caroline Gravel, Ons Marsit, Dounia Rouabhia, Marie-Annick Clavel, Erwan Salaun, mathieu bernier, Kim O'Connor, Philippe Pibarot, Josep Rodes-Cabau, Jean-Michel Paradis, Jonathan Beaudoin
Journal: Circulation (2022)

Introduction: Residual mitral regurgitation (MR) is associated with worse outcomes after transcatheter edge to edge mitral valve repair (TEER) but is difficult to assess by echocardiography. Shear-stress induced by MR leads to altered Von Willebrand factor activity (vWF:Act), also reflected by increased closure time with adenosine diphosphate (CT-ADP), representing potential ways to screen for residual MR. CT-ADP can be assessed easily during TEER and is known to normalize swiftly after the correction of turbulent flow. Hypothesis: The improvement of CT-ADP is quick enough to allow real-time procedural guidance. Methods: We enrolled 39 patients undergoing TEER. MR severity was assessed by echocardiography during the procedure, 24-hours and 1-month post-TEER. CT-ADP was measured before TEER, 8 minutes after each clip deployment, 1 hour and 24 hours after the procedure. CT-ADP values were related with vWF:Act and MR severity at each time point. Results: Of 39 patients after TEER, 6 (15%) and 8 (21%) patients had residual MR ≥ moderate at 24-hours and 1-month respectively. There was no significant change in CT-ADP values during the procedure. The decrease of CT-ADP was however significant 1-hour post-TEER with stable values at 24-hours (last clip deployment: 136 [110-193]; 1 hour: 99 [82-131] and 24 hours: 95 [82-121] seconds, p&lt;0.001). Concomitant increase in vWF:Act was observed after the procedure (baseline: 1.76 [1.29-2.05]; 1 hour: 1.84 [1.79-1.85] and 24 hours: 2.32 [1.84-2.5] IU/ml, p=0.002). Patients were stratified into 3 groups according to the residual MR grade at 1 month (≤ mild vs. moderate vs. &gt;moderate). CT-ADP was not different among the groups (p=0.74). However, the difference in CT-ADP (1 month vs baseline values) was associated with MR improvement at the same time points (r=0.50; p=0.007). Conclusions: Although CT-ADP decreases after TEER and correlates with vWF:Act and MR improvement at 1 month, this decrease is first observed 1 hour after the procedure and does not seem to be quick enough to provide real-time monitoring of MR severity during TEER.
Abstract 11835: Different Dynamic Luminal Compression of Intramural Segment During Cardiac Cycle in Anomalous Aortic Origin of Coronary Arteries Revealed by Ivus Gated Sequences
Authors: Giovanni Maria Formato, Mauro L Agnifili, Luca Arzuffi, Antonio Rosato, Valentina Ceserani, Karina Geraldina Zuniga Olaya, Francesco Secchi, Miriam Deamici, Michele Conti, Francesco Bedogni, Alessandro Frigiola, Mauro Lo Rito
Journal: Circulation (2022)

Introduction: Anomalous Aortic Origin of Coronary Artery (AAOCA) with intramural (IM) segment is associated with risk of sudden cardiac death (SCD). The pathogenic mechanism is believed to be the IM compression caused by the aorta expansion during effort. However, the IM compression occurrence and magnitude during the cardiac cycle remain unknown. Hypothesis: We hypothesized that the IM segment is subjected to dynamic compression during different phases of cardiac cycle with a luminal area and roundness smaller in systole than in end-diastole. Methods: Lumen dynamics was derived from IVUS pullbacks of N=35 AAOCA (N=23 with IM tract) after retrospective image-based gating to identify cardiac cycles. The cyclic change of area (A) and roundness (R=minimum/maximum lumen axis) of ostial, distal IM, and extramural (EM) tracts were described after manual lumen segmentation. The systolic phase was identified, in each patient, by estimating normal PQ and QT intervals from image-based gating. Results are presented with median and interquartile range. One-tailed Wilcoxon signed-rank test (p&lt;0.025) assessed differences between systolic and diastolic phases in each tract. Results: A systolic reduction of roundness was observed in ostium [R systole = 0.5 (0.2), R diastole = 0.6 (0.3), flattening: -7% (10), p=0.01] and distal IM segment [R systole = 0.7 (0.2), R diastole = 0.8 (0.2), flattening: -6% (16), p=0.004]. No-IM segments showed normal behaviour and remained circular during the entire cardiac cycle. The distal IM had an area reduction during systole [A systole = 8.3 (2.3) mm 2 , A diastole = 8.1 (2.9) mm 2 , narrowing: -4% (11), p=0.009] that was not observed in all other segments (Figure 1). Conclusion: AAOCA with IM segment has pathological dynamic compression mainly in systole. Studying AAOCA behaviour with IVUS during the cardiac cycle may help to evaluate and quantify the severity of the narrowing.
Abstract 11624: Family Income and Cardiovascular Disease Risk in American Adults
Authors: Abdul M Minhas, Vardhmaan Jain, Monica Li, Robert Ariss, Marat Fudim, Erin D Michos, Salim S Virani, Laurence Sperling, Anurag Mehta
Journal: Circulation (2022)

Background: Socioeconomic status is an often-overlooked risk factor for cardiovascular disease (CVD). Low family income is a measure of socioeconomic status and may portend worse CVD burden. Therefore, we assessed the association of family income with cardiovascular risk factor and disease burden in American adults. Methods: This retrospective analysis included data from participants aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) cycles between 2005 and 2018. Family income to poverty ratio (PIR) was calculated by dividing family (or individual) income by the poverty guidelines specific to the survey year and used as a measure of socioeconomic status. The association of PIR with the presence of cardiovascular risk factors and CVD as well as cardiac mortality and all-cause mortality was examined. Results: We included 35,932 unweighted participants corresponding to 207,073,472 weighted, nationally representative participants. Participants with lower PIR were often female and more likely to belong to race/ethnic minorities (non-Hispanic Black, Mexican American, other Hispanic). In addition, they were less likely to be married/living with a partner, to attain college graduation or higher, or to have health insurance. In the adjusted analysis, the prevalence odds of diabetes mellitus, hypertension, coronary artery disease (CAD), congestive heart failure (CHF), and stroke largely decreased in a step-wise manner from highest (≥5) to lowest PIR (&lt;1) (Table 1). In the adjusted analysis, we also noted a mostly dose-dependent association of PIR with the risk of all-cause and cardiac mortality during a mean 5.7 and 5.8 years of follow up, respectively. Conclusions: Public policy efforts should be directed to alleviate these disparities to help improve cardiovascular outcomes in this vulnerable subgroup.
Abstract 11461: The Hemodynamic Gain Index is an Independent Predictor of Adverse Outcomes, and Comparable to Peak Oxygen Consumption in Patients With Chronic Heart Failure With Reduced Ejection Fraction
Authors: Thanat Chaikijurajai, Timothy Engelman, Yuping Wu, J. Emanuel Finet, Vicente Morales Oyarvide, Justin L Grodin, Wai Hong W Tang
Journal: Circulation (2022)

Introduction: The hemodynamic gain index (HGI) is a novel simple parameter calculated from resting and peak systolic BP (SBP) and heart rate (HR) during exercise testing. It is a predictor of mortality in population-based cohorts. However, the prognostic significance of the HGI in chronic HFrEF has not been well studied. Hypothesis: The HGI is independently associated with adverse outcomes, and is comparable to other cardiopulmonary exercise testing (CPET) parameters. Methods: Medical records of 1,067 consecutive HFrEF patients (EF ≤ 40%) undergoing CPET for symptom evaluation from 12/2012 to 9/2020 were reviewed. HGI was calculated using the formula, [(SBP peak x HR peak )-(SBP rest x HR rest )]/(SBP rest x HR rest ). Patients with missing vital signs, hypotensive or bradycardic response to exercise were excluded. Primary outcome was the composite endpoint of all-cause mortality, LVAD implantation, and heart transplantation. Multivariable Cox proportional hazard models were used with subgroup analyses based on median age, sex, BMI of 35 kg/m 2 , respiratory exchange ratio (RER) of 1.05, and beta-blocker use. ROC curves with AUCs were used to compare HGI, peak VO 2 , VE/VCO 2 slope and peak end-tidal pressure of CO 2 (PEtCO 2 ). Results: We included 954 HFrEF patients (mean age was 56.3 ± 12.0 years, 72% men, 17% with BMI ≥ 35 kg/m 2 , 86% on beta-blockers, and 73% with RER &gt; 1.05). During a median follow up time of 946 days, the incidence of the composite outcome was 331 (34.7%). After adjustment for age, sex, BMI, comorbidities, and EF, higher HGI was independently associated with lower risk of the adverse outcomes in the main cohort (hazard ratio per unit increase 0.46, 95%CI 0.35 to 0.59, p &lt; 0.001), and all subgroups, except for patients with BMI ≥ 35 kg/m 2 ( Figure 1A ). The HGI was also comparable to peak VO 2 , and outperformed VE/VCO 2 slope and PEtCO 2 ( Figure 1B ). Conclusions: The HGI is an independent predictor of adverse outcomes, and comparable to peak VO 2 in patients with chronic HFrEF.
Abstract 11768: Reducing the Burden of the Opioid Epidemic by Adopting a Novel Pain Control Strategy Utilizing Pectoral Nerve Block in Adults Undergoing Transvenous Cardiac Device Implants
Authors: Jamarcus Brider, Bridget Lee, Brandon Doty, Feross Al-Hindi, Devi Nair
Journal: Circulation (2022)

Introduction: Despite early mitigation efforts, the opioid pandemic in the United States has persisted and affected many Americans. A public health emergency was declared regarding opioid prescriptions. Alternative approaches to postoperative pain control after transvenous cardiac device implants (TCDI) in adults have not been described. Methods: We report a single center retrospective analysis of 153 consecutive patients that underwent TCDI from January to August 2021 with ultrasound guided pectoral nerve block (PNB) using liposomal bupivacaine prior to implant for postoperative pain control. Pain scores (0-10) were recorded systematically during recovery, at discharge, and at wound check follow up. Opioid use in the postoperative period was recorded as well. Results: A total of 153 patients were evaluated, 50% female with a mean age of 71.2 years. All patients received PNB successfully with no device site infection or hematoma. The mean Visualized Analog Scale (VAS) pain scores at 1, 3, and 5 hours after the procedure, at discharge, and at follow up were 1.93, 1.22, 1.10, 1.05, and 0.125 respectively. No patients required opioids for pain control throughout the average postoperative period of 14 days. Conclusion: Pectoral nerve block with liposomal bupivacaine can be administered safely before TCDI and provides adequate pain control without need for opioid use postoperatively. Further research is needed to assess broad scale implications of this approach to larger patient populations. Figure 1: Ultrasound Guided PNB, pectoralis major (PM), pectoralis minor (Pm) Graph of the average postoperative pain score and opioid use during follow up visit over time
Abstract 12035: Cardiotoxicity-Based Model for Assessment of Drug Value in Breast Cancer
Authors: Ohad Oren, Deepak L Bhatt
Journal: Circulation (2022)

Introduction: Cardiovascular toxicity mediated by chemotherapy drugs has important implications on the clinical outcomes of patients with breast cancer. We created a multi-component drug value framework incorporating efficacy, safety, cost, and cardiovascular toxicity data to define the overall value of standard regimens. The impact of heart failure incidence on the value score of each regimen was evaluated. Methods: The NCCN guidelines were reviewed, and four standard chemotherapy regimens used in non-metastatic HER-2 negative breast cancer were selected. PubMed was reviewed for randomized clinical trials establishing the role of each regimen. Data on the efficacy (defined as 5-year survival) and toxicity (defined as incidence of the most frequent grade 3 toxicity) profile of each regimen were extracted. Data on regimen-specific heart failure incidence at follow up were collected from prospective studies. Regimen-specific costs were derived from a recent observational cohort study. Total drug value scores (range 2.2-8.6, traditional, 2.9-11.7 upgraded) were computed and the effect of cardiotoxicity data on drug value scores was evaluated. Results: Anthracycline-containing regimens had lower mean drug value scores than anthracycline-free regimens (5.3, 61.6% versus 7.4, 86.0%) using a traditional value system based on efficacy, safety, and cost. When data on heart failure incidence were incorporated into the value assessment, anthracycline-containing regimens had lower relative value scores (mean decrease 10.7%) while anthracycline-free combinations had higher relative scores (mean increase 4.3%), compared with a traditional model. Regimen-specific value scores were modified by the addition of heart failure data. Drug value assessments that included efficacy, safety and cost showed superiority of docetaxel, adriamycin, cyclophosphamide (TAC) relative to cyclophosphamide, methotrexate, fluorouracil (CMF) (7.1, 82.6%, 6.6, 76.7%) and the addition of heart failure incidence data reversed that trend (8.6, 73.5%, 9.6, 82.0%). Conclusions: Inclusion of cardiovascular toxicity data modifies the value scores of standard chemotherapy regimens used in breast cancer and likely provides a more patient-centric value assessment.
Abstract 11756: Tracking High-Density Lipoprotein Functionality in Diabetic and Non-Diabetic Patients With Toe Amputations
Authors: Zahra Lotfollahi, Joanne T Tan, Joe Dawson, Robert Fitridge, Christina A Bursill
Journal: Circulation (2022)

Introduction: High-density lipoprotein cholesterol (HDL-c) levels have an established inverse association with cardiovascular event risk. More recently, the focus has shifted to HDL functionality as an improved metric of its predictive value and is impaired in patients with coronary arterial disease. HDL-c levels have been reported to inversely associate with the risk of amputation in patients with diabetic foot ulcers (DFUs), but whether HDL functionality is predictive of wound closure success is currently unknown. Methods: Eighteen diabetic and eight non-diabetic patients with toe/s amputations had blood collected at: (1) the time of surgery, (2) four weeks and (3) six months post-amputation. Wound areas were tracked until closure by 3D camera. Blood was collected from 20 healthy age and gender-matched participants. From blood, HDL was isolated and its functionality tested via (1) cholesterol efflux from macrophages, and (2) anti-inflammatory and (3) pro-angiogenic effects in endothelial cells. Results: Wound closure was faster in non-diabetic than diabetic amputation patients at four weeks (186.6%, P =0.12). Diabetic HDL promoted less cholesterol efflux at four-weeks (37.8%, P &lt;0.05) and six-months (45.6%, P &lt;0.01) post-amputation, compared to non-diabetic HDL. Incubation of non-diabetic HDL with endothelial cells caused greater reductions in inflammatory markers RELA (51.4%, P &lt;0.01), CCL5 (46.9%, P &lt;0.01), CCL2 (15.3%, P &lt;0.05) and ICAM-1 (33.1%, P &lt;0.05) than non-diabetic HDL. Non-diabetic HDL elicited greater endothelial cell angiogenesis with increased Matrigel tubule number at four weeks post amputation (46.15%, P &lt;0.05), compared to diabetic HDL. There were significant correlations between the rate of wound closure and HDL-c levels (R 2 = +0.62, P &lt;0.05), CCL2 (R = -0.64, P &lt;0.05) and ICAM-1 (R = -0.71, P &lt;0.05). Conclusion: In toe amputation patients, HDL-c levels and inflammatory HDL functionality markers associate with the rate of wound closure. HDL from diabetic patients had impaired cholesterol efflux capacity, reduced anti-inflammatory effects and was less able to promote angiogenesis, compared to non-diabetic HDL.
Abstract 11941: Accuracy of OCT Core Labs in Determining Coronary Artery Plaque Composition
Authors: Aleksandra Gruslova, Shashank Singh, Taylor Hoyt, Deborah Vela, Yuliya Vengrenyuk, Louis M Buja, Silvio Litovsky, Joel Michalek, Akiko Maehara, Annapoorna Kini, Takashi Akasaka, Hector Garcia-Garcia, Ik-kyung Jang, Jouke Dijkstra, Lorenz Raber, Thomas Milner, Marc D Feldman
Journal: Circulation (2022)

Introduction: Intravascular optical coherence tomography (OCT) provides a high-resolution representation of coronary atherosclerosis. However, the accuracy of OCT image interpretation is unknown. We present a blinded study of histologically identified OCT human plaque composition by leading international OCT core labs. Hypothesis: Human readers are unable to accurately identify all plaque compositions. Methods: Seven recognized OCT core labs (Japan, Netherlands, Switzerland, USA) participated. Each laboratory was provided 51 OCT image clips recorded from ex vivo human coronary arteries within 24 hours of death and had regions of interest processed for H&amp;E stain. Nine plaque components were identified and are listed in Results. Each OCT core lab was asked to blindly read OCT images and complete a questionnaire indicating one of nine possible plaque types. Kappa coefficient ( k ) was used ( k &lt; 0.5 poor agreement, k &gt; 0.5 high agreement) to measure intra-reader agreement; the median k is reported for each plaque component. Results: High agreement was demonstrated in identifying stable plaque including fibrous (0.93), calcium (0.83), layered plaque (1.0), and ThCFA (0.63), in contrast to unstable plaque including calcified nodule (0.50), lipid pool (0.35), macrophages/foam cells (0.35), TCFA (0.39), and necrotic core (0.22). When categories were restricted to Fibrous, Calcium, and Lipids, with Lipids expanded to include lipid pool, TCFA, and necrotic core, similar to an OCT core lab definition, k for Lipids increased to 0.61. Conclusions: Results suggest that participating OCT core labs can accurately identify combined lipid categories (lipid pool, TCFA, and necrotic core), fibrous tissue and calcium. However, accuracy is reduced when reading more sophisticated unstable plaque components. Study results emphasize the need for the development of OCT plaque composition analysis with artificial intelligence.
Abstract 11904: Lipoprotein(a) Integrates Monocyte-Mediated Thrombosis and Inflammation in Atherosclerotic Cardiovascular Disease
Authors: Robert S Rosenson, Ashley Tate, QINZHONG CHEN, Olga Grushko, Dilna Damodaran, Priscilla Mejia, Michael Boffa, Marlys L Koschinsky, Jagat Narula, Sascha N Goonewardena
Journal: Circulation (2022)

Introduction: Lipoprotein (a) [Lp(a)] drives atherosclerotic cardiovascular disease (ASCVD) through multiple mechanisms including cholesterol accumulation, inflammation, and thrombosis. However, the effects of Lp(a) on monocyte activation and monocyte-mediated thrombosis are unknown. Hypothesis: Lp(a) itself can activate monocytes, driving inflammation and thrombosis in parallel. Methods: We employed systems biology approaches consisting of proteomics, transcriptomics, and mass cytometry to define the immune cellular and molecular phenotypes in ASCVD subjects with high and low Lp(a) levels and leveraged cell models to define the mechanisms through which Lp(a) drives monocyte inflammation and thrombosis. We included study participants with CHD who were aged 18 to 80 years with Lp(a) concentrations &gt; 150 nmol/L (cases) and &lt;75 nmol/L (controls). Results: Circulating markers of inflammation (CCL3, CD40) and vascular dysfunction (PAR1, tissue factor [TF]) were elevated in subjects with high Lp(a) levels compared with those with low Lp(a) levels. Additionally, although total monocytes levels and hs-CRP levels were similar between the groups, CD14+ monocytes from ASCVD subjects with an elevated Lp(a) were primed and expressed more TF at baseline and in response to stress. Mechanistically, we found that Lp(a) itself can activate monocytes through Toll-like receptors (TLR) and nuclear factor kappa B (NFκB) signaling, driving both TF expression and TF activity (Figure). Conclusions: Overall, these studies are the first to link Lp(a) to monocyte-mediated inflammation and thrombosis in ASCVD subjects, demonstrating a novel mechanism through TLR2, NFκB, and monocyte TF through which Lp(a) amplifies immunothrombotic risk.
Abstract 12160: Sex Differences in Outcomes of Percutaneous Coronary Intervention in Octogenarians: A Retrospective Cohort Study From National Inpatient Sample 2016-2019
Authors: Nischit Baral, Annabelle S Santos Volgman, prem parajuli, Govinda Adhikari, Krishna Bashyal, Niranjan Ojha, Hassan Saleh, Shravya Balmuri, Arvind Kunadi, Basel Abdelazeem, Abdul Arida, Islam Obeidat, Amith Reddy Seri, Soumya Kambalapalli, Timir K Paul
Journal: Circulation (2022)

Introduction: The role of sex-based differences in the outcomes after principal percutaneous coronary intervention (PCI) in octogenarians is not well studied. Hypothesis: There are no differences in outcomes of PCI in octogenarians based on sex. Methods and Results: From 2016 to 2019, 37,147 hospitalizations (unweighted sample) for principal PCI procedures were identified. Among the principal PCI procedures performed, 44.9% (n = 16,660) were performed in females, and 55.2% (n = 20,487) in males (p &lt; 0.001), 82.4% in Whites, 5.4% in Blacks, 6.4% in Hispanics, and 2.6% in Asians. 20,986 (56.5%) principal PCI hospitalizations had a Charlson comorbidity index (CCI) of three or higher. The mean age for Octogenarians was 83.6 ± 2.7 years. Compared to males, the females were slightly older (mean age: 83.8 vs. 83.5; p &lt; 0.001), had higher prevalence of diabetes mellitus (20.5% vs 18%, p&lt;0.001) and lower Charlson comorbidity index (CCI) of three or higher (53.6% vs. 58.9%, p &lt;0.001). Females had higher incidence of cardiogenic shock (4.9% vs 4.2%, p=0.002), higher in-hospital mortality (4% vs 3%, p&lt;0.001) and longer length of stay (LOS) (4.4 days vs 4.1 days, p&lt;0.001). Multivariate regression analysis showed that, compared to males, females had a significantly higher odds of in-hospital mortality (aOR: 1.23; 95% CI: 1.10, 1.37; p &lt;0.001) and cardiogenic shock (aOR: 1.17; 95% CI: 1.06, 1.30; p=0.002) after controlling for age, race, hospital region, hospital teaching status, income, insurance provider, and CCI. From 2016-2019, in octogenarians, the annual incidence of principal PCI hospitalizations increased from 127 per 100,000 hospitalizations in 2016 to 137 per 100,000 hospitalizations in 2019, p&lt;0.001. Conclusions: The incidence of PCI done in octogenarians is rising every year. Females have an increased likelihood of in-hospital mortality, longer LOS, and cardiogenic shock.